Written by Crystal Zuzek

How Texas hospitals are working to improve patient safety and cultivate environments that lead to better outcomes.

For Texas hospitals, patient safety is priority No. 1 and a constant work in progress. After all, improving care involves multiple stakeholders — executives, physicians, advanced practice providers, nursing staff and other support staff — carrying out coordinated, evidence-based procedures and implementing quality and safety programs at the department and organization level. But across the board, Texas hospital executives have found that instilling quality and safety values in their leadership and personnel cultivates an environment that breeds better outcomes and fewer adverse events.

Angela Shippy

It shouldn’t come as a surprise that a large portion of hospitals’ safety efforts focuses on decreasing and preventing medical errors. Angela Shippy, M.D., senior vice president and chief quality officer at Memorial Hermann Health System in Houston, said hospitals across Texas can accomplish these goals by using smart technology, sound processes, evidence-based clinical practices and well-trained people. “Adopting high-reliability principles allows for mindfulness around events and appropriately looks to the staff on the frontlines to be part of the solution,” said Dr. Shippy.

Russell Meyers

As Russell Meyers, President/CEO of Midland Memorial Hospital, explained, technology plays a crucial role in a hospital’s ability to collect data from patient medical records and measure performance and outcomes, both necessary to create and implement effective quality and safety initiatives. “It is important to be able to collect data in reports and develop analytic platforms to obtain useful information from the data,” said Meyers.

A Protected Process

Gleaning meaningful patient safety data is essential; using those numbers to execute processes and plans that keep patients safer is paramount. That is where unencumbered communication about medical errors, hospital-acquired infections and other safety events at the hospital level is critical. Patient Safety Organizations provide a protected, confidential environment to promote frank discussions among health care organizations about safety events and their identified root causes and contributing factors.

Karen Kendrick

Prior to the creation of PSOs, “hospitals investigated adverse events, learned valuable lessons, and implemented improvement strategies; however, there was no means by which organizations could effectively share this learning beyond their own facility without significant risk,” said Karen Kendrick, RN, vice president of clinical initiatives at the Texas Hospital Association Foundation. She oversees THA’s PSO and explained that today, hospitals can take advantage of the confidential and legally protected environment PSOs offer, openly sharing information about adverse events and developing measures to help prevent them in the future.

“Hospital leaders at THA’s 91 PSO member facilities learn from one another and proactively reduce the potential for similar adverse events in their facilities,” said Kendrick. “Participants frequently state how helpful it is to discuss safety events openly and hear from their peers. When an adverse safety event occurs, organizations conduct a root cause analysis and then implement corrective action. If the learning is not shared outside that one facility, it is possible that similar events, with similar causes, may happen elsewhere.”

Erol Akdamar

Erol Akdamar, FACHE, president of Medical City Healthcare in Dallas, said participation in a PSO has benefited patients from a quality and safety perspective. “PSOs create a secure environment in which data can be collected, aggregated and analyzed. The process improves quality by identifying and reducing risks and hazards associated with patient care,” said Akdamar.

A Coordinated Approach

Developing best practices in patient safety and coordinating programs across multiple facilities are mammoth tasks. At Medical City Healthcare, professional safety directors, vice presidents of quality, nursing officers and medical officers all play a role in developing and implementing safety initiatives. Akdamar said Medical City Healthcare’s culture of safety revolves around educating all the organization’s leaders in the Institute for Healthcare Improvement’s six domains of Leading a Culture of Safety.


Six Domains of Leading a Culture of Safety

  1. Establishing a compelling vision for safety
  2. Building trust, respect and inclusion among all employees
  3. Selecting, developing and engaging the board of directors
  4. Prioritizing safety in the selection and development of leaders
  5. Leading and rewarding a just culture
  6. Establishing organizational behavior expectations

To ensure patient safety at Medical City Healthcare, Akdamar added that all department leaders at all system hospitals hold daily safety huddles to discuss specific strategies and tactics to keep patients safe, eliminate harm and improve patient outcomes. Examples of hospital initiatives that have improved patient safety and quality of care at Medical City Healthcare include the Alternatives to Opioids pain management and addiction prevention program and the Team STEPPS program.

According to Akdamar, ALTO reduced opioid utilization by 21% in Medical City Healthcare emergency departments in just one year. “Physicians are using less addictive but effective alternatives, including nonopioid patches, nonopioid pain medications, trigger point injections and other pain relief methods,” said Akdamar. Medical City hospitals use the Agency for Healthcare and Research Quality’s Team STEPPS framework to optimize patient outcomes by improving communication and teamwork skills among nurses and physicians.

Pam Stoyanoff

Pam Stoyanoff, president and chief operating officer of Methodist Health System in Dallas, said the effective deployment of patient safety procedures across multiple facilities involves a multipronged approach. Methodist’s Board Quality Committee meets every other month and reviews patient safety metrics and improvement efforts. Each hospital has an active patient safety committee and holds a daily patient safety huddle. The organization’s systemwide patient safety cabinet shares best practices and identifies effective initiatives to advance patient safety.

Midland Memorial Hospital has worked to address and reduce the number of HAIs and hospital-acquired pressure injuries. Meyers cited the hospital’s focus on internal objectives to achieve reductions in the following:

  • Catheter-associated urinary tract infections by utilizing a nurse-driven protocol for Foley catheter removal based on the American Hospital Association’s Stop CAUTI initiative;
  • Pressure injuries in high-risk patients via prophylactic foam padding;
  • Pneumonia for patients on ventilators through the implementation of ventilator-associated pneumonia bundles;
  • Complications for critical care patients through an early mobilization program; and
  • Central line-associated bloodstream infections by implementing a multidisciplinary prevention approach based on the Centers for Disease Control and Prevention’s guidelines and toolkits.

On the hospital level, Stoyanoff said each department at Methodist Health System follows specific patient safety initiatives. “For example, our perinatal leaders have all worked to achieve maternal/child and reduction of maternal mortality designations.”

Stoyanoff said Methodist Health System has improved diabetes care and colon cancer screening by more than 30% through the organization’s Silver Fellowship Program, offered once a year. “Participants spend six months in training sessions on advanced performance improvement and complete a project,” she said.

Stoyanoff also points to Methodist Health System’s significant reduction of sepsis mortality as another achievement.

Patient Safety in Action

Putting quality and patient safety programs into practice has paid off for Medical City Healthcare. Akdamar cited a rate of Clostridium difficile infections that is 39% below expected rates and a CLABSI rate 54% below expected rates. He said the system’s average septic shock mortality is “well below” National Institutes of Health benchmarks. And by taking an average of 43 minutes — lower than the American Stroke Association’s 60-minute recommended time frame — to administer life-saving medication for acute ischemic strokes, he said Medical City staff can improve a patient’s probability of recovering from a stroke.

Stoyanoff said Methodist Health System has improved diabetes care and colon cancer screening by more than 30% through the organization’s Silver Fellowship Program, offered once a year. “Participants spend six months in training sessions on advanced performance improvement and complete a project. By focusing considerable effort on sepsis care, Methodist Health System has been able to significantly reduce sepsis mortality,” she said.

“Making patient safety improvements is a continuous, never-ending process. We regularly evaluate the published top 10 safety concerns, identify any gaps within the hospital system, learn from published best practices and develop specific action plans,” said Dr. Shippy.